A discussion with my coworkers recently reminded me of the wide variability in the size and nature of the organizations that utilize our software products. Behavioral Health organizations range from solo, part-time psychologists, psychiatrists, social workers and professional counselors in private practice to large community-based organizations that provide inpatient, outpatient, intensive outpatient, and home-based care to those requiring mental health and substance abuse treatment.
As a result of this wide variability, the individuals with whom we deal in our provision of technical support services range from highly-trained medical and mental health billing/coding specialists and practice business managers to the teenage child or neighbor of the doctor who happened to be in need of a summer job. We are often amazed by the differences…by how much some billing specialists know and how little information others have.
One of the biggest surprises for me is how often highly trained mental health professionals are willing to entrust their businesses to individuals who have no training to do such a job. We are sometimes asked why our software does not do “x” for them. We explain that the software is a tool to be used by someone who knows mental health/medical billing to accomplish the needed tasks. It will not magically do billing for someone who has no idea how to do that job.
My niece works in a medical practice and is studying for the American Health Information Management Association’s (AHIMA) Certified Coding Specialist – Physician Based exam. I went to AHIMA’s site to see what the content is for this certification and was amazed at the breadth of the knowledge required to achieve the certification. The AAPC is a different organization. . . of professional coders. . . that also offers training, certification, support and networking. Both of these are aimed at individuals who work in medical coding and billing.
Some people who work in behavioral health assume that the billing job must be much simpler for mental health because it contains a much narrower range of services than a general medical practice. Just ask any experienced behavioral health billing specialist, and you will find out that it is not simple at all. Just because the range of services provided in behavioral health is much smaller does not mean that the person doing the billing requires less knowledge about billing and collections and dealing with insurance carriers.
Mental health services were “managed” by insurance carriers much earlier than most other specialties. As a result, there are rules and requirements for obtaining authorization for treatment that have a 30 year history. While “parity” was legislated in 2008 and the final rule for implementation promulgated in 2010, implementation has been slow and many consumers are not even aware that their plan might cover mental health services at the same rate they cover general medical care.
To expect someone who has never worked in a health care setting and has not previously done medical or mental health billing to have any idea about parity or treatment authorizations or copays or coordination of benefits or take-backs is just not reasonable. Medical billing is complicated and behavioral health billing has its own subtleties and complexities that are different.
So what is an employer to do? Here are some quick suggestions:
- Recognize that the person who is doing your billing is running a crucial part of your business. You should expect them to be a business professional.
- Do NOT expect someone who earns minimum wage to know how to do behavioral health billing. If you find a qualified biller who is willing to work for such a wage, they are selling themselves short.
- If your staff is struggling with how to bill, get them information. The Center for Medicare Services (CMS) is an outstanding resource. If a claim will pass Medicare muster, it will also pass the requirements of most other insurers.
- Invest in training for your staff. Having your staff thoroughly learn the software product you are using will earn money for your organization.
This is an arena in which I am sure many of you have experience and opinions. Please share your comments below. If you have additional recommendations for employers, please let us know.
Patricia Kelly says:
Accolades to you for stressing the importance of having a highly qualified billing staff and pract. manager. When I was hired at CCB many many years ago, they had a software system in place that did just about nothing. I did my homework as the new pract. manager and found SOS………….we having been using it right along and love the ease of the program. However, you are correct in stating that one must have a good background in billing. Mental Health billing is quite complex and if one doesn’t stay on top of it…..errors will occur and payments will not be received. ‘TRAINING IS THE KEY” FOR ANYONE wanting to have a practice that can completely rely on their billing team/office staff. There are many workshops out there that offer new updates to the complicated issues involving MH along with simply getting on line and asking the right questions. In addition, we are constantly keeping up with our carriers to ensure that our billing matches their new updates. Bottom line……when you have a great software system such as SOS and knowledge of MH billing and an office staff that cares…….you will have a practice that continues to grow.
Kathy says:
You know I agree with you, Patricia. Thanks for stating it so clearly and articulately!
Vince Bellwoar says:
Well said Kathy! We have learned the hard way…but at least we learned! About 14 years ago we had a programmer write us a billing program. That lasted about 2 years then I found SOS. We started SOS on one stand alone computer in 2000. Since then we’ve grown 11% each year for the last 10. Much of that was made possible by SOS’ ability to grow with us…and hiring and TRAINING staff.
As we are in the process of replacing a staff member (receptionist), we now know that all candidates must minimally have a background in healthcare
Kathy says:
A practice as large as yours must learn this, Vince. It costs you too much not to. Investing in your staff’s skills and training…and investing in high quality staff people goes a long way toward the success of your business…just like in any other business.
Nancy says:
Bless you for your post. I have struggled with this with my providers for years. Seems they think anybody can bill insurance companies. 2 of our providers went out on their own thinking they could save money without staff and do their own billing and authorizations………what a rude awakening they have had. Loss of income being #1. I read anything that comes acrossed my desk from you folks and value your support and knowledge.
Kathy says:
Thanks, Nancy. We try, but it is not possible for us to train staff members on how to do billing. We can add info whenever possible and I am glad to hear it is valuable to you. Let us know what areas might be helpful for us to address.
Seth says:
Speaking for the support department here at SOS, I would like to elaborate on Kathy’s last suggestion. Software training is ON TOP OF general education regarding medical billing and reimbursement. Without the more general knowledge, specialized software knowledge won’t do the trick. CMS offers free billing seminars, sometimes even specialized mental/behavioral health seminars, that are really quite good. Even if you don’t do much or any Medicare billing, attending one of these sessions will go a long way toward understanding issues you will encounter with commercial insurers.
Kathy says:
I don’t think we can emphasize this enough. First, make sure your staff get general training in mental health/medicall billing. Then, IN ADDITION TO THIS, get them training on your software. Thanks for clarifying and emphasizing this, Seth.